How Superbug Spreads among Regional Hospitals: A Domino Effect

A moderate increase in vancomycin-resistant enterococci (VRE) at one
hospital can lead to a nearly 3 percent increase in VRE in every other
hospital in that county, according to a study in the August issue of the
American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

VRE is one of the most common bacteria that cause infections in healthcare facilities.

Researchers from the Johns Hopkins Bloomberg School of Public Health,
Pittsburgh Supercomputing Center (PSC), University of Pittsburgh, and
University of California, Irvine created the Regional Healthcare
Ecosystem Analyst (RHEA), a mathematical and computational model, to
track the movement between hospitals of VRE-colonized patients (patients
carrying the organism but not yet infected) over the course of a year
in Orange County, Calif. Using this model, they were able to assess how
increases or decreases in one hospital’s VRE affected neighboring
hospitals.

Not only did the investigators find that a moderate increase in VRE
at any one hospital caused an average 2.8 percent increase throughout
the county (range: 0 percent to 61 percent), they also discovered that
hospitals in the most populated area of the county had an even greater
likelihood of spreading VRE throughout the network. Additional modeling
identified a potential for “free-riders”—hospitals that will experience
decreases in VRE incidence due to other hospitals’ infection control
efforts without initiating any infection prevention measures of their
own.

The study points to the underutilization of patient-sharing data
between regional hospitals, the importance of inter-hospital
communication and collaboration in decreasing VRE rates, and the scope
of variables that must be considered in analyzing the outcome of any one
infection prevention initiative.

“Our study demonstrates how extensive patient sharing among different
hospitals in a single region substantially influences VRE burden in
those hospitals,” states Bruce Y. Lee, MD, MBA, lead author and
Associate Professor of International Health and Director of Operations
Research, International Vaccine Access Center, at the Johns Hopkins
Bloomberg School of Public Health. “Lowering barriers to cooperation and
collaboration among hospitals, for example, developing regional control
programs, coordinating VRE control campaigns, and performing regional
research studies, could favorably influence regional VRE prevalence.”

Vancomycin-resistant enterococci are resistant to vancomycin, the
drug often used to treat serious infections for which other medicines
may not work. VRE can live in the human intestines and female genital
tract without causing disease. However, sometimes they can cause
infections of the urinary tract, the bloodstream, or of wounds
associated with catheters or surgical procedures. There are an estimated
20-85,000 cases of VRE each year in U.S. hospitals.

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